Therapeutic Anticoagulation for Isolated Calf Deep Vein Thrombosis

Utter, Garth H.; Dhillon, Tejveer S.; Salcedo, Edgardo S.; Shouldice, Daniel J.; Reynolds, Charles; Humphries, Misty D.; White, Richard

doi:10.1001/jamasurg.2016.1770

Cited by 47 publications

(52 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 14 studies included, 6 were RCTs, 20-25 4 prospective cohort studies, [26][27][28][29] and 4 retrospective cohort studies. [30][31][32][33] Baseline characteristics of included studies and study outcomes are shown in ►Tables 1 and 2. Twelve of the studies exclusively included patients with isolated distal DVT.…”

Section: Included Studiesmentioning

confidence: 99%

“…Seven studies comparing one or more outcomes of therapeutic anticoagulation to conservative management met eligibility criteria for this analysis. 20,21,25,26,30,31,33 Three of the seven included studies were RCTs. 20,21,25 For the separate outcomes of proximal extension and PE, moderate level (I 2 ¼ 50% p ¼ 0.09) and significant heterogeneity (I 2 ¼ 59% p ¼ 0.033) were present, respectively (►Supplementary Figs.…”

Section: Anticoagulation Compared With Conservative Managementmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review and Meta-analysis Comparing Anticoagulation versus No Anticoagulation and Shorter versus Longer duration of Anticoagulation for Treatment of Isolated Distal Deep Vein Thrombosis

Lim¹,

Ariyarajah

Oldmeadow

et al. 2017

Semin Thromb Hemost

View full text Add to dashboard Cite

Isolated distal deep vein thrombosis (DVT) represents an important clinical problem but there is no consensus regarding its management. The aim of this review was to evaluate the safety, efficacy, and shorter versus longer duration of anticoagulation in patients with isolated distal DVT. A systematic search was conducted using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews. Studies reporting rates of symptomatic pulmonary embolism (PE), recurrent DVT, proximal extension, and/or major bleeding were included. Fourteen studies (six randomized controlled trials, eight cohorts) involving 2,918 patients met the eligibility criteria (with a total of 13 meeting criteria for the meta-analysis). Compared with no anticoagulation, anticoagulation was associated with a significant reduction in proximal extension (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.13–0.67; p < 0.004), recurrent DVT (OR: 0.16; 95% CI: 0.04–0.65; p = 0.01), and the composite end-point of proximal extension/PE (OR: 0.34; 95% CI: 0.16–0.72; p = 0.005); however, no significant differences in PE (OR: 0.47; 95% CI: 0.17–1.34; p = 0.16) or major bleeding (OR: 1.49; 95% CI: 0.33–6.86; p = 0.60) were observed. Anticoagulation for a longer duration (≥8 vs. ≤6 weeks) was associated with a significant reduction in proximal extension (OR: 0.23; 95% CI: 0.11–0.48; p < 0.001) but not for other outcomes.

show abstract

Section: Included Studiesmentioning

confidence: 99%

Section: Anticoagulation Compared With Conservative Managementmentioning

confidence: 99%

A Systematic Review and Meta-analysis Comparing Anticoagulation versus No Anticoagulation and Shorter versus Longer duration of Anticoagulation for Treatment of Isolated Distal Deep Vein Thrombosis

Lim¹,

Ariyarajah

Oldmeadow

et al. 2017

Semin Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…As distal DVT is frequent and accounts for up to half of all lower limb DVT, this is an important knowledge gap. Furthermore, whether distal DVT needs to be treated with therapeutic anticoagulation is still debated and anticoagulant treatment is not routinely recommended in international guidelines . Thus, in clinical practice, not all patients with distal DVT are offered therapeutic anticoagulation, which could have an impact on their risk of developing future PTS.…”

Section: Introductionmentioning

confidence: 99%

Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

Galanaud

Righini

Collen

et al. 2020

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background After a proximal lower limb deep vein thrombosis (DVT; involving popliteal veins or above), up to 40% of patients develop postthrombotic syndrome (PTS) as assessed by the Villalta scale (VS). Poor initial anticoagulant treatment is a known risk factor for PTS. The risk of developing PTS after isolated distal DVT (infra‐popliteal DVT without pulmonary embolism), and the impact of anticoagulant treatment on this risk, are uncertain. Methods Long‐term follow‐up of CACTUS double‐blind trial comparing 6 weeks of s.c. nadroparin (171 IU/kg/d) versus s.c. placebo for a first symptomatic isolated distal DVT. At least 1 year after randomization, patients had a PTS assessment in clinic or by phone using the VS. Results After a median follow‐up of 6 years, PTS was present in 30% (n = 54) of the 178 patients who had a PTS assessment. PTS was moderate or severe in 24% (n = 13) of cases. There was no statistically significant difference in prevalence of PTS in the nadroparin versus placebo groups (29% versus 32%, P = .6), except in patients without evidence of primary chronic venous insufficiency (9% versus 24%, P = .04). Rates of venous thromboembolism recurrence during follow‐up in the nadroparin and placebo groups were, respectively, 8% (n = 7) and 14% (n = 13; P = .2). Conclusion After a first isolated distal DVT, the risk of PTS is substantial but much lower than that reported after proximal DVT. Anticoagulation with nadroparin doesn't provide any clear benefit to prevent PTS, except in patients without preexisting chronic venous insufficiency. Anticoagulation might be associated with a lower risk of venous thromboembolism recurrence.

show abstract

“…Finally, 24 studies met the inclusion criteria and were included in the analysis (4072 patients) . Among the included studies, 20 compared anticoagulation with no anticoagulation, and four compared different durations of anticoagulant treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Isolated distal deep vein thrombosis (IDDVT) is a common disorder with a variable prevalence across studies, owing to differences in clinical settings and diagnostic methods . In patients with untreated IDDVT, the rate of proximal extension or pulmonary embolism was reported to vary between 1% and 22% . Furthermore, the optimal management of IDDVT in terms of both the need for anticoagulant treatment and the duration of treatment is undefined.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation in patients with isolated distal deep vein thrombosis: a meta‐analysis

Franco

Giustozzi

Agnelli

et al. 2017

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background The optimal management of patients with isolated distal deep vein thrombosis (IDDVT), concerning both the need for anticoagulation and its duration, is undefined. Objectives We performed a meta-analysis of randomized and cohort studies in patients with IDDVT to assess the clinical benefit of: (i) anticoagulation versus no anticoagulation; and (ii) anticoagulant treatment for 6 weeks versus for > 6 weeks. Methods The primary outcome of this analysis was recurrent venous thromboembolism (proximal propagation, recurrence of deep vein thrombosis, and pulmonary embolism). Data were pooled and compared by the use of odds ratio (OR) and 95% confidence interval (CI). Results A reduction in the rate of recurrent venous thromboembolism was observed in patients who received anticoagulation relative to those who did not receive anticoagulation (either therapeutic or prophylactic) (20 studies, 2936 patients; OR 0.50, 95% CI 0.31-0.79), without an increase in the risk of major bleeding (OR 0.64, 95% CI 0.15-2.73). The rate of pulmonary embolism was lower in anticoagulant-treated patients than in controls (15 studies, 1997 patients; OR 0.48, 95% CI 0.25-0.91). A lower rate of recurrent venous thromboembolism was observed in patients who received > 6 weeks of anticoagulant therapy than in those who received 6 weeks of anticoagulant therapy (four studies, 1136 patients; OR 0.39, 95% CI 0.17-0.90). Conclusions In patients with IDDVT, anticoagulation (both therapeutic and prophylactic) reduces the rate of recurrent venous thromboembolism and the incidence of pulmonary embolism as compared with no anticoagulation, without an increased risk of major bleeding. Anticoagulation for > 6 weeks should be preferred over shorter durations.

show abstract

Therapeutic Anticoagulation for Isolated Calf Deep Vein Thrombosis

Abstract: Rates of proximal DVT or PE are low after isolated calf DVT. Therapeutic anticoagulation is associated with a reduction of these outcomes but an increase in bleeding.

Cited by 47 publications

References 18 publications

A Systematic Review and Meta-analysis Comparing Anticoagulation versus No Anticoagulation and Shorter versus Longer duration of Anticoagulation for Treatment of Isolated Distal Deep Vein Thrombosis

A Systematic Review and Meta-analysis Comparing Anticoagulation versus No Anticoagulation and Shorter versus Longer duration of Anticoagulation for Treatment of Isolated Distal Deep Vein Thrombosis

Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

Anticoagulation in patients with isolated distal deep vein thrombosis: a meta‐analysis

Contact Info

Product

Resources

About